CDC Updates Guidance for Infants Born to Mothers With Possible Zika Virus Infection During Pregnancy

The Centers for Disease Control and Prevention (CDC) today issued updated interim clinical guidance for health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy. This update includes information that has become available since the August 2016 release of the previous guidance.

Zika virus continues to be a public health threat to pregnant women and their infants. Despite the lower number of Zika cases in 2017 than at this time during 2016, Zika cases continue to be reported by many countries around the world. Zika virus infection during pregnancy can cause serious damage to the brain of the developing fetus. It can lead to congenital Zika syndrome in babies, a pattern of birth defects that includes brain abnormalities, vision problems, hearing loss, and problems moving limbs. Babies with congenital infection may also appear healthy at birth but have underlying brain defects or other Zika-related health problems.

“There’s a lot we still don’t know about Zika, so it’s very important for us to keep a close eye on these babies as they develop,” said CDC Director Brenda Fitzgerald, M.D. “Learning how best to support them will require a team approach between healthcare providers and families.”

The updated recommendations emphasize that it is important for pediatric health care providers to assess risk of congenital Zika virus infection, to communicate closely with obstetrical providers, and to remain alert for any problems that may develop in infants without birth defects born to mothers with possible Zika virus exposure during pregnancy.

Updated guidance for care of infants with possible Zika exposure

To assist health care providers with clinical management decisions, the guidelines define three groups of infants:
1. Infants with birth defects consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure during pregnancy (regardless of the mother’s Zika virus test results).
2. Infants without birth defects consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy.
3. Infants without birth defects consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure during pregnancy but without laboratory evidence of Zika virus infection during pregnancy.

The new guidance provides updated information on interpreting laboratory test results for infants and infant follow-up care:
• Recommendations for vision and hearing screening have been updated.
• Some previously recommended screenings (e.g., thyroid screening, hearing screening at 4- to 6-months of age) are no longer recommended because of a lack of data on whether these screenings are needed.
• For infants with birth defects consistent with congenital Zika syndrome, healthcare providers should monitor for an expanded list of potential problems. These include difficulty breathing, difficulty swallowing, and hydrocephaly (also called water on the brain) after birth. In addition, care and follow-up of these infants no longer depends on the infants’ Zika virus testing results.
• Infants without birth defects consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy should receive an eye examination by an ophthalmologist.
• For infants without birth defects consistent with congenital Zika syndrome born to mothers with exposure to Zika virus but no laboratory evidence, Zika testing and clinical evaluation beyond the standard evaluation and routine preventive care are not routinely recommended.
• The updated guidance provides a review of new data and clarification of the guidance for prenatal diagnosis (serial ultrasounds and amniocentesis).

Coordinated care and established medical home recommended
Because the types of services needed to care for infants with congenital Zika syndrome are complex, CDC recommends coordinated care by a multidisciplinary team and an established medical home (an approach to healthcare that helps ensure care is coordinated and infants receive appropriate services). As a critical component of patient care and early identification of any developmental delays, families should be empowered to be active participants in their child’s monitoring and care.
To inform the updated recommendations, CDC, in collaboration with the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), hosted clinical experts in August 2017 to review emerging evidence and collect individual expert input regarding the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection. CDC evaluated the evidence and considered individual input when developing the updated interim guidance. Presentations are available: https://www.cdc.gov/zika/hc-providers/training/forum.html. As more information becomes available, this guidance will be updated.

Segment Description: Becky Smith, MD, medical director of infection prevention at Duke University Hospital, discusses a presentation she gave at IDWeek 2019 on a case of serial transmission of NDM-1 Klebsiella pneumon